Provider Demographics
NPI:1972904266
Name:VASSELL, DENNETTE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENNETTE
Middle Name:
Last Name:VASSELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 N DRUID HILLS RD # 301
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3105
Mailing Address - Country:US
Mailing Address - Phone:470-377-3980
Mailing Address - Fax:
Practice Address - Street 1:2155 W PARK CT STE D
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3511
Practice Address - Country:US
Practice Address - Phone:470-234-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist